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197 Cards in this Set
- Front
- Back
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Measurement of the posterior fetal neck in profile view |
Nuchal translucency (NT) |
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Excellent screening for aneuploidy & Down syndrome |
Nuchal translucency *Sensitivity for Down syndrome is between 60-90% (about >= 70%) |
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Nuchal translucency is done between _________ weeks |
11 to 14 weeks |
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How many "mm" is consider fetal anomaly in Nuchal translucency? |
>= 3.0 mm |
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Initial 2nd trimester serum screen; used to screen for neural tube defects (NTDs) |
Maternal serum AFP (MSAFP) |
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Enumerate the Quadruple screen |
1. MSAFP 2. Beta-hCG 3. Estriol 4. Inhibin |
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Identify the congenital anomalies:
MSAFP: Decreased Beta-hCG: Decreased Estriol: Decreased Inhibin: Decreased |
Trisomy 18 (Edwards syndrome) |
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Identify the congenital anomalies:
MSAFP: Decreased Beta-hCG: Elevated Estriol: Decreased Inhibin: Elevated |
Trisomy 21 (Down syndrome) |
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In amniocentesis beyond _____ weeks to obtain karyotype, once chorion & amnion have fused. |
15 weeks |
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In amniocentesis it uses cultures ( ____ days) or fluorescent in situ hybridization/FISH ( ______ hrs) |
5-7 days 24-48 hrs |
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Complications of amniocentesis |
1. Rupture of membranes 2. Preterm labor 3. Fetal injury |
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It is a prenatal screening method where the catheter is placed into the intrauterine cavity (either transabdominal or transvaginal). |
Chorionic Villus Sampling (CVS) |
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CVS is done between _________ weeks |
9-12 weeks |
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Complications of CVS |
1. Preterm labor 2. Premature ROM 3. Previable delivery 4. Fetal injury 5. Fetal limb anomalies |
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It is a prenatal screening method, where the needle is placed transabdominally into uterus & umbilical cord is phlebotomized. It is used for fetal CBC determination, karyotyping, intrauterine transfusion. |
Fetal Blood Sampling via Percutaneous umbilical blood sampling (PUBS) |
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Time of fertilization until 8 weeks (10 weeks gestational age) |
Embryo ***Conceptus aka embryo |
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After 8 weeks until time of birth |
Fetus |
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Between delivery to 1 year |
Infant |
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37 weeks to 42 weeks |
Term |
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AOG is usually _____ weeks more than the Developmental Age. |
2 weeks |
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By "quickening" ●Multigravida: _______ weeks |
16 to 18 weeks |
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By "quickening" ●Primigravida: _______ weeks |
18 to 20 weeks |
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HCG is produced by __________ in placenta to maintain the corpus luteum in early pregnancy. |
syncytiotrophoblasts |
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Corpus luteum produces _________ which maintains the endometrium. |
progesterone |
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HCG is doubles every _______ hours. |
48 hours |
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HCG detected in maternal serum or urine by _________ days after ovulation. |
8 to 9 days |
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Urine pregnancy test and serum assays test for the _________ subunit. |
beta |
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HCG will rise to a peak of __________ mIU/mL by 10 weeks, decrease throughout the _____ trimester, then level off at around 20,000 - 30,000 mIU/mL; Plateau approximately at _____ weeks. |
100,000 mIU/mL 2nd trimester 16 weeks |
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1st sonographic evidence of pregnancy; implants eccentrically. |
Gestational sac
*double decidual sign surrounding the gestational sac *seen during 4 to 5 weeks. |
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It is a fluid in the endometrial cavity with ectopic pregnancy; seen in the midline. |
Pseudogestational sac / pseudosac |
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It is an echogenic ring with an anechoic center; confirms intrauterine location of pregnancy. |
Yolk sac *Seen during Middle of 5th week. |
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It is the linear structure adjacent to yolk sac; and cardiac motion is noted |
Embryo *seen during > 6 weeks |
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Crown-rump-length is predictive of gestational age within 4 days is seen in sonographic up to ______ weeks. |
12 weeks |
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Fetal heart sounds ● _______ weeks: Doppler UTZ |
10 weeks |
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Fetal heart sounds ● _______ weeks in 80% of women: Stethoscope |
20 weeks |
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Fetal heart sounds ● _______ weeks: heart sounds are expected to be heard in all |
22 weeks |
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Pregnant women are at an increased risk for complicated UTI (e.g. pyelonephritis) due to |
1. Increased urinary stasis from mechanical compression of ureters 2. Progesterone-mediated smooth muscle relaxation |
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Measurement of the uterus: between _____ and _____ weeks, fundic height in cm correlates closely with AOG in weeks. |
20 and 34 weeks |
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1st trimester: early screening for aneuploidy is offered between _______ weeks either with: ●UTZ for NT + serum PAPP-A & free beta-hCG |
11 to 13 weeks |
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Cell free DNA (cfDNA) is detected as early as _____ weeks. |
5 weeks |
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Second trimester: screening for MSAFP between ________ weeks. |
15 to 18 weeks |
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Between ______ weeks: most patients are offered a screening UTZ to screen for common fetal abnormalities (Congenital Anomaly Scan) |
18 to 20 weeks |
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Name the sign in Spina Bifida: ●It is the concave frontal bones |
Lemon sign |
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Name the sign in Spina Bifida: ● A cerebellum that is pulled caudally & flattened |
Banana sign |
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RhoGAM is given at ______ weeks to Rh negative patients |
28 weeks |
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In breech presentation, external cephalic version (ECV) is offered at _______ weeks. |
37 to 38 weeks |
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Laxatives is avoided during 3rd trimester due to risk of |
preterm labor |
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Constipation is due to decreased bowel motility due to |
INCREASED Progesterone ** leads to increased water absorption from the GI tract |
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Dehydration is due to |
1. Expanded intravascular space
2. Increased third spacing |
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Dehydration may cause contractions secondary to |
cross-reaction of vasopressin with oxytocin receptors |
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Edema is due to |
Compression of IVC & pelvic veins by the uterus ** leads to increased hydrostatic pressure in the lower extremities. |
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Hemorrhoids is due to |
1. Increased venous stasis 2. IVC compression |
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Urinary frequency is due to |
1. Increased compression of the bladder by the growing uterus
2. Increased intravascular volume & GFR leading to increased urine production. |
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Calories is increased by 100-300 kcal/day; by _______ kcal/day when breastfeeding. |
500 kcal/day |
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RDA for protein |
70-75 g/day OR 1g/kg/day |
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RDA for Iron (elemental) for low risk |
27 mg/day |
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RDA for Iron (elemental) for large women, twin pregnancy, anemia |
60-100 mg/day |
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RDA for Iodine |
220 ug/day |
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RDA for Calcium |
1,000 mg/day |
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RDA for folate for ALL women |
0.4 to 0.8 mg/day |
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RDA for folate that can prevent NTDs |
400 mcg/day |
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RDA for folate with previous NTD baby |
4 mg/day |
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RDA for Vitamin C |
80 to 85 mg/day |
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TDap vaccine is preferably between _______ weeks. |
27 to 36 weeks |
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Contraindicated vaccines in pregnancy |
1. Measles 2. Mumps 3. Rubella 4. Varicella 5. HPV |
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Normal fetal activity |
10 fetal movements in up to 2 hours is NORMAL |
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Test of uteroplacental function |
Contraction stress test (CST) |
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Normal CST |
3 or more contractions lasting 40 seconds or more in a 10-minute period |
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Positive CST (abnormal) |
Late fetal heart deceleration following >= 50% of decelerations even if the contraction frequency is < 3 in 10 minutes. |
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Test for fetal condition |
Non-stress test |
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NST in >= 32 weeks |
Accleration >= 15 bpm from baseline, lasts for >= 15 secs, but < 2 mins from onset to return. |
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NST in < 32 weeks |
Accleration >= 10 bpm from baseline, lasts for >= 10 secs, but < 2 mins from onset to return |
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Reactive (reassuring) NST |
2 accelerations in 20 minutes |
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Nonreactive NST |
less than 2 accelerations |
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Biophysical Profile (BPP) Components |
BATMAN!!! 1. Fetal breathing 2. Amniotic fluid volume 3. Fetal tone 4. Fetal movement 5. Nonstress test |
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Normal BPP score |
Score of 10 *Normal, non-asphyxiated fetus 8/10 (Normal AFV) 8/8 (NST not done) |
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BPP score 8/10 (Decreased AFV) |
Interpretation: Chronic fetal asphyxia is suspected Management: DELIVER |
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BPP score of 6/10 |
Interpretation: Possible fetal asphyxia Management: Deliver if: ● AFV abnormal ● Normal AFV > 36 weeks with favorable cervix |
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Neural Control of BPS Activity ● Fetal heart Reactivity |
CNS center: Medulla & Posterior hypothalamus AOG: 24 -26 weeks |
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Neural Control of BPS Activity
● Fetal Breathing |
CNS center: ventral surface of 4th ventricle
AOG: 20-21 weeks |
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Neural Control of BPS Activity ● Fetal movement |
CNS center: Cortex-nuclei
AOG: 9 weeks |
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Neural Control of BPS Activity ● Fetal tone |
CNS center: Cortex-Subcortical Area
AOG: 7.5 to 8.5 weeks |
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Used as a predictor of fetal lung maturity |
Lecithin to sphingomyelin (L/S) ratio ** L/S ratio increases as the pregnancy progresses. |
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As the lungs mature, lecithin _______ while sphingomyelin ________ beyond about 32 weeks. |
increases, decreases |
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It secrete a surfactant that uses phopholipids |
Type II pneumocytes |
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Other tests for fetal lung maturity |
1. Levels of phosphatidylglycerol 2. Saturated phosphatidyl choline 3. Presence of lamellar body count 4. Surfactant to albumin ratio |
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Functions of cervix during pregnancy |
1. Maintenance of barrier function to protect the reproductive tract from infection
2. Maintenance of cervical competence despite increasing gravitational forces
3. Extracellular matrix changes that allow progressive increases in tissue compliance. |
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Identify what kind of pelvis.
● Oval-shaped pelvis with AP diameter at the pelvic inlet greater than transverse diameter. ● Large sacrosciatic notches ● Convergent side walls, prominent ischial spines, & narrow pubic arch. ● The baby is occiput posterior |
Anthropoid Pelvis |
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Identify what kind of pelvis ● Classic female pelvis, with a posterior sagittal diameter only slightly shorter than the anterior sagittal diameter. ●Posterior pelvis is rounded & wide. ● Side walls are straight ● Spines are not prominent ● Pubic arch is wide |
Gynecoid Pelvis |
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Platypelloid pelvis is __________ with a short AP and a _______ transverse diameter. _________ sacrosciatic notches are common. |
flattened, wide transverse diameter, wide sacrosciatic notches |
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● In the android pelvis, the _________ sagittal diameter at the inlet is much _________ than the anterior sagittal diameter, limiting the use of the posterior space by the fetal head. ● The sidewalls are ________, the spines are pominent, and the pubic arch is __________. |
● Posterior sagittal, shorter ● Convergent, narrow |
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Factors that increase the probability of success trial of labor after cesarian (TOLAC) |
1. Prior vaginal delivery 2. Spontaneous labor |
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Factors that decrease the probability of success trial of labor after cesarian (TOLAC) |
1. Increased maternal age 2. Hispanic or African American ethnicity 3. Postdates gestation 4. Maternal obesity |
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The L/S ratio in amniotic fluid is close to 1 until about _______ weeks of gestation, when the concentration of lecithin begins to rise. |
34 weeks of AOG |
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For pregnancies of unknown duration but otherwise uncomplicated, the risk of RDS is relatively low when the L/S is at least _______. |
2:1 |
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A risk of RDS of 40% exists with an L/S ratio of ________. |
1.5 : 2 |
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A risk of RDS of 73% exists with an L/S ratio of ________. |
< 1.5 |
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A phospholipid that enhances surfactant properties |
Phosphatidylglycerol (PG) **Identification of PG in amniotic fluid provides considerable reassurance that RDS will not develop |
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False-negative rate for the BPP is |
< 0.1% |
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False-positive rate for the BPP are relatively ________, with _________ specificity |
frequent; poor |
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In patients with profile scores of 8 but with spontaneous decelerations, the rate of cesarian delivery indicated for fetal distress has been ________. |
25% |
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A sensitive serum quantitative pregnancy test can detect hCG levels by __________ days postovulation. |
8 to 9 days |
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It is the most accurate means of estimating gestational age |
Measurement of the fetal crown-rump length.
**In the 1st trimester, this UTZ measurement is accurate to within 3 to 5 days |
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Serum progesterone levels that indicate a nonviable pregnancy. |
< 5 ng/mL |
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Serum progesterone levels that indicate a normal intrauterine pregnancy. |
> 25 ng/mL |
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A 1-hour glucose challenge test should be performed between ___ & ___ weeks' gestation |
24 & 28 weeks **Administration of 50 g oral glucose solution followed by a 1-hr venous glucose determination. |
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Certain women at high risk for GDM should be screened earlier (ie, at 1st prenatal visits) |
1. Women with a hx of gestational DM 2. BMI > 30 3. Family hx of DM 4. Age > 35 5 Hx of fetal macrosomia in a prior pregnancy |
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Increased fluid retention manifested by pitting edema of the ankle and legs is a normal finding in _______ pregnancy. |
late **During pregnancy, ● decrease colloid osmotic pressure ● decrease plasma osmolality ● Increase venous pressure created by partial occlusion of the vena cava by the gravid uterus. |
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Round ligament pain is more frequently experienced on the right side due to the ________ of the uterus that commonly occurrs during pregnancy. |
dextrorotation |
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Classic symptoms of Round Ligament Pain |
Right-sided groin pain described as sharp & occuring with movement & exercise |
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The fundal height in "cm" has been found to correlate with gestational age in weeks with an error of _____ cm from 16 weeks to 36 weeks. |
3 cm |
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Transvaginal UTZ can detect fetal cardiac activity as early as ______ weeks after a missed period. |
5 weeks |
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With a traditional stethoscope, FHT can be heard starting between ____ & ____ weeks' gestation. |
17 & 19 weeks |
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Doppler stethoscope can detect FHT by ____ weeks' gestation. |
10 weeks |
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It is a procedure where the breech fetus is manipulated through the abdominal wall to change the presentation to vertex |
External cephalic version (ECV) |
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Goal of ECV |
To increase the proportion of vertex presentations among fetuses formerly in breech presentation near term |
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Conditions where a trial of labor for a pregnant woman with a fetus in the breech presentation may be appropriate |
1. Fetus is FRANK BREECH 2. Flexed head 3. Normohydramnios 4. Estimated weight between 2500 g & 3800 g 5. Adequate pelvis |
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A fetus with a hyperextended, or "stargazer," head has higher risk of ___________ injury during vaginal breech delivery |
spinal cord |
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It refers to a pregnancy that has reached beyond 42 0/7 weeks AOG from LMP |
Postterm pregnancy |
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It refers to a pregnancy that has reached between 41 0/7 weeks and 41 6/7 weeks AOG. |
Late-term pregnancy |
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Overall incidence of postterm pregnancy is approximately |
5% |
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If a patient has a favorable cervix at 41 weeks, it is reasonable to offer induction of labor, because the chance of successful vaginal delivery is very _____. |
high |
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Components of Bishop Score |
1. Dilation 2. Effacement 3. Station 4. Consistency 5. Position |
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It is a hygroscopic dilator that is placed in the cervical canal and absorbs water from the surrounding cervical tissue |
Laminaria |
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Menstrual cycle days _____ to _____ is the narrow window of endometrial receptivity to blastocyst implantation. |
days 20 to 24 |
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Estrogen that is responsible for menopause |
E1: estrone |
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Estrogen that is most potent in reproductive age. |
E2: estradiol |
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Estrogen that is responsible for pregnancy |
E3: estriol |
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Number of follicles AT BIRTH |
2 Million oocytes |
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Number of follicles at puberty |
400,000 follicles |
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Depletion rate of follicles from puberty to 35 years old |
1,000 follicles/month |
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Total follicles released during reproductive age |
400 follicles |
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Atresia (apoptosis) of follicles |
99.9% |
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Primary oocyte is formed by the ____ fetal month |
5th |
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Primary oocyte is arrested in ________ from 5th fetal month until the onset of puberty. |
prophase I **will complete the 1st meiotic division at the onset of puberty |
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Secondary oocyte is formed after completion of _________. |
meiotic I |
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Secondary oocyte release of the 1st polar body during _________. |
ovulation |
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Secondary oocyte arrested in ________ until fertilization. |
metaphase II |
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In 2° oocyte, completion of 2nd meiotic division occurs if there is _______. |
fertilization |
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This follicle, destined to ovulate, and produces estrogen. |
Dominant follicle |
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Name the follicle: It is a single layer of granulosa cells surrounding the ovum |
Primordial follicle |
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In antral & vesicular follicle, elevated FSH causes accelerated growth of ____ to ___ primary follicles each month. |
6 to 12 |
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In antral & vesicular follicle, antrums is forms due to accumulation of __________ secreted by the Granulosa cells |
follicular fluid (with high concentration of estrogen ) |
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Estrogen synthesis is based on a theory known as the |
Two-cell theory OR Two-cell, two-gonadotropin theory |
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It is a hormone that stimulates production of androgens (androstenedione) from cholesterol & pregnenolone in the theca cells. |
Luteinizing Hormone |
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Hormone that stimulates the conversion of androgens to estrogens (estrone) |
FSH |
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Androgens are transported into _______ cells |
granulosa |
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Ovulation usually takes how many days |
3 to 4 days |
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Preovulatory follicles increase estrogen secretion ___ to ____ hours before release of ovum with LH surge. |
34 to 36 hours |
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LH peaks ____ to ____ hours before ovulation |
10 to 12 |
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Hormone responsible for the rupture of follicular wall with release of the mature ovum or ovulation |
Progesterone & Prostaglandins |
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Fertilization of the ovum must occur within _______ hours of ovulation or it degenerates |
24 hours |
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Luteal phase is constant at ___ to ___ days |
12 to 14 days |
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It occurs after ovulation when the corpus luteum develops |
Luteinization |
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Corpus luteum is a transient endocrine organ that will rapidly regress ___ to ___ days after ovulation. |
9 to 11 days |
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Luteolysis may due to the following: 1. Decrease of circulating LH in the ________ phase 2. Decrease sensitivity of ______ cells 3. Apoptosis |
1. late luteal 2. luteal |
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Major hormone in follicular phase |
Estrogen |
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Major hormone in luteal phase |
Progesterone |
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Corpus luteum produces what hormone during the early part of the pregnancy. |
Progesterone |
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During luteal phase, the placenta develops its own synthetic function at ___ to ____ weeks of gestation. |
8 to 10 weeks |
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In proliferative endometrium, straight to slightly coiled lined by ___________________ columnar epithelium. |
pseudostratified columnar epithelium |
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During early secretory phase, coiled glands with a slightly widened diameter lined by _________ columnar epithelium.
*** scattered mitoses in the glands |
simple columnar epithelium (contains clear subnuclear vacuoles)
** Luminal secretions are seen. |
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In late secretory phase, serrated, dilated glands with intraluminal secretion lined by _______ columnar cells |
short columnar cells |
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Day of cycle of Proliferative Phase |
Before 14 days |
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Key features of proliferative phase |
Mitoses (straight to tightly coiled tubules) |
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Day of cycle of Early Secretory Phase |
17 to 18 days |
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Key features of Early Secretory Phase |
Subnuclear vacuoles **Loose stroma |
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Day cycle of Mid-secretory Phase |
Day 19 to 25 |
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In mid-secretory phase, what is the key features on day 19 to 22? |
Stromal edema
** Dilated glands luminal with irregular outline and secretions |
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In mid-secretory phase, what is the key features on day 23? |
Focal decidua around spiral arteries **Dilated glands lumina with irregular outline secretions |
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In mid-secretory phase, what is the key features on day 24 to 25? |
Patchy decidua
**Decidua throughout stroma. ** "Sawtooth" glands |
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Day cycle of Late Secretory |
Days 26 to 27 |
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In late secretory, what is the key features? |
Extensive decidua
** Prominent granulated lymphocytes ** Prominent "sawtooth" glands |
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Day cycle of menstrual phase |
Day 28+ |
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Key features of Menstrual Phase |
Stromal crumbling ** Disrupted glands Secretory exhaustion Regenerating epithelium |
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Functionalis layer is shed and regenerated from the deepest basalis layer almost ____ times during the reproductive lifetime of most women. |
400 times |
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Day ____ of menses, the epithelial surface of the endometrium has been restored, and revascularization is in progress. |
Day 5 |
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The first indication of progesterone effects |
Subnuclear vacuolization |
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Features of secretory phase in endometrium |
1. Well-developed subnuclear vacuoles in all endometrial gland cells 2. No mitoses in the glands 3. Rising levels of progesterone 4. Rapid secretory differentiation |
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Withdrawal of _________ causes the endometrium to slough initiating the menstrual phase. |
progesterone |
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______ levels begin to slowly rise in the absence of negative feedback, and follicular phase starts again. |
FSH |
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How many percent of menstruating women suffers from dysmenorrhea? |
50% ** 10% of which is are incapacitated for 1 to 3 days each month. |
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Idiopathic menstrual pain without identifiable pathology, often occuring with the initiation of ovulatory menstrual cycles. |
Primary Dysmenorrhea |
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Localized overgrowths of endometrial tissue, containing glands, stroma, and blood vessels, covered with epithelium. |
Endometrial Polyp ** Possible cause: estrogen stimulation |
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3 components of endometrial polyp |
1. Endometrial glands 2. Endometrial stroma 3. Central vascular channels |
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Diagnosis of Endometrial Polyp |
Transvaginal UTZ; Hysteroscopy Management: Operative hysteroscopy |
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It is the presence of endometrial glands & stroma in the uterine myometrium |
Adenomyosis |
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2 pathological presentations of Adenomyosis |
1. Symmetrical (Diffuse) 2. Assymetrical (Focal/Adenomyoma) |
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Abnormal uterine bleesing due to adenomyosis is thought to be a result of |
1. Altered uterine contractility 2. Enlarged endometrial surface 3. Increased endometrial vascularity |
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On pelvic examination in adenomyosis, the uterus is _______ enlarged, globular, usually _____ times the normal size; usually does not larger than _____ weeks unless with concomitant pathology such as myoma. |
diffusely; 2-3x; 14 weeks |
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Histologic diagnosis of Adenomyosis |
Presence of endometrial glands & stroma more than one-lowered field (2.5 mm) from the basalis layer |
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Most sensitive tests of adenomyosis |
MRI > Vaginal UTZ |
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Pathognomonic findings for adenomyosis |
Anechoic avascular cysts scattered throughout the myometrium. |
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Definitive treatment of adenomyosis |
Hysterectomy |
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Most common presenting symptom of endometrial cancer |
Malignancy or Hyperplasia (AUB-M) |
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Risk factor of AUB-M |
Increased circulating levels of estrogen |
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Present menorrhagia occurred at the time of 1st menstrual period |
Coagulopathy (AUB-C) |
